What is hospice care?
Hospice care has been in the news recently with the announcement that former president Jimmy Carter has begun receiving home hospice care. You may be wondering what hospice care is, who it’s appropriate for, and how it fits into your estate plan.
What is hospice care?
Hospice care is a form of health care that focuses not on treating or curing illness but on relieving pain symptoms and ensuring the comfort of a terminally ill person. As the Texas and New Mexico Hospice Organization puts it, “Hospice is a medically directed, interdisciplinary team-managed program of services that focuses on the patient/family as the unit of care. Hospice care is palliative rather than curative, with an emphasis on pain and symptom control, so that a person may live the last days of life fully, with dignity and comfort, at home or in a home like setting.”
Who is hospice care for?
Generally, to qualify for hospice care, a patient must have an incurable or terminal medical condition and anticipated remaining life expectancy of less than six months. It is appropriate either when no further curative treatments exist or when the patient (or their surrogate decision-maker) does not wish to pursue further treatment. A patient with capacity may decide to enter hospice care or an incapacitated patient’s surrogate decision maker may elect it for them.
Many people do not enroll in hospice until they are near death. In a recent study, 35% of hospice patients died within a week and roughly half died within three weeks. However, a significant minority live six months or more. As of this writing, I know of a patient from a guardianship case I worked on who has been on hospice care for nearly a year, as they continue to meet the qualifications for it. Family members often comment after seeing the benefits of hospice that they wish they had started hospice care earlier.
How long can a patient remain on hospice care?
Hospice is end-of-life care but is not limited to just the final days of one’s life. Also, a person may qualify for hospice care and remain on it for more than six months. There is no time limit to how long one may be on hospice care, but a patient may be discharged from hospice if their condition improves such that they no longer qualify, and the patient may re-enter hospice later should they requalify.
Where does a patient receive hospice care?
Hospice care can be provided in the patient’s home, assisted living or other long-term care facility, hospitals, or freestanding hospice centers.
Who pays for hospice care?
Medicare provides a hospice benefit, as do most private health insurance plans and Medicaid. For patients without any coverage, they may self-pay. Hospice treatment usually costs much less than hospital treatment.
Is hospice care the same thing as euthanasia?
No. Euthanasia is physician-assisted suicide, in which the physician, at patient request, administers a fatal dose of a suitable drug to ensure a painless death. Hospice care neither attempts to speed up nor prevent death but rather, to provide comfort and pain relief to the patient to help manage symptoms.
Why might someone choose hospice?
For a patient facing terminal illness, like former president Carter, hospice may provide greater physical and emotional comfort than continuing more aggressive treatment. It may improve quality of life not only by reducing suffering but by providing patient-centered care, allowing the patient to spend their final days according to their wishes. For many, this may mean spending final days comfortably at home surrounded by family away from the noise and stress of a hospital. This is what former president Carter has chosen for himself.
Hospice care may also provide comfort and support to the patient’s family.
How does hospice care relate to my estate planning?
An important piece of any estate plan is the designation of medical power of attorney to make medical decisions for you should the day come when you cannot make such decisions for yourself. If you are incapacitated your agent under medical power of attorney may elect hospice care for you. As with any other medical decisions, it’s important to ensure that the people you name in your medical power of attorney are familiar with your wishes so they may honor them.
In your advance directive to physicians (aka “living will”) you indicate your preferences to receive or decline life support in certain circumstances. However, even if you indicate that you wish to be kept alive using life-sustaining treatments, if you or your surrogate decision-maker elect hospice care, you will be given only the treatments needed to keep you comfortable and will not receive life-sustaining treatments. In other words, regardless of your initial life support preference, once you enter hospice care, you no longer receive treatments intended to prolong your life. Instead, the treatment goal will be comfort care.
A DNR form is generally not required in order to enter hospice care. However, if a patient wants only comfort care, it may also be appropriate to execute a DNR form.